Health
October 10, 2008 02:18 PM
beingwell magazine Fall 2008
By: Kim Goggins
Women who are suffering through menopause but afraid to take hormone therapy (HT) will want to know that Health Canada has recently approved a low-dose hormone therapy treatment to relieve symptoms.
It’s the first new hormone therapy (combination estrogen and progestin) made available in Canada since 2002 when the Women’s Health Initiative (WHI) Estrogen plus Progestin Study suggested a link between HT and an increased risk of breast cancer and cardiovascular disease.
The new product is welcomed by physicians like Dr. Jennifer Blake of the Society of Obstetricians and Gynaecologists of Canada (SOGC), who says many of her patients can benefit from the new drug called Activelle(R) LD.
“I had a patient who came in to see me who was 49, whose menopause had come when she was only 42. She had such severe vaginal dryness and pain she hadn’t been able to have intercourse since then. Her doctors were telling her, ‘You can’t be on hormone therapy; try this, try that; try lubricants.’ Here’s a woman who, for (seven) years of her married life, has not been able to have intercourse,” Dr. Blake recalls. “(HT) can relieve a number of symptoms. It’s the single most effective therapy we have for hot flashes. It improves sleep quality, it reduces aches and pains and it improves vaginal health and dryness.”
Canadian women spend more than a third of their lives in the post-menopausal period. Usually occurring between the age of 48 and 52, menopause is the permanent cessation of menstruation when the ovaries no longer release an egg each month and cease to produce the female sex hormones estrogen and progestogen.
The mean age of the women who participated in the WHI study was 63 – much older than those who suffer with menopausal symptoms – and further analysis of the data has shown that HT can be beneficial for younger women.
“The study was misunderstood. It did report on a risk of breast cancer (for younger women), but in fact, it was lower than the risk of breast cancer that we have always counselled women about with the use of hormone therapy,” Dr. Blake says. “It’s present; it’s not a very high risk in terms of a risk factor but there’s no question that if you put millions of women on hormone therapy routinely that this becomes an important thing to think about.”
However, the study still provided valuable information, she notes.
“The study in 2002 said the way we were doing things needed to improve. We needed to make hormone therapy safer because menopause remains a problem for women and its symptoms are really distressing to a lot of women who go through it,” she says. “Women want safe options and they want effective options because right now we have women, because of fear, that are pursuing therapies that are not particularly effective.”
Dr. Peter Watt, physician leader of the maternal child program at Southlake Regional Health Centre, says many women pay more attention to the perceived risk of HT causing breast cancer than they do obesity, which is a greater risk factor.
“You don’t see people avoiding obesity the way that people avoid hormones,” says Dr. Watt, adding that he is cautiously optimistic the data on younger participants in the study will help women see the benefits of HT.
“I can recommend hormone therapy but patients won’t take it,” he notes. “It’s encouraging but I think there’s still a lot of skepticism among the public. The pendulum swings from hormone therapy is good for everyone to hormone therapy is bad for everyone to now, hormone therapy has its place. That’s the way things go in medicine.”
At one time, HT was also recommended for the prevention of cardiovascular disease in women without menopausal symptoms but that stopped in 2002, when the data showed an increased risk of cardiovascular disease in older women. HT is a good option to lessen menopausal symptoms in women who have premature menopause with no history of breast cancer.
“Most practitioners would suggest supplementation of hormones up until the age of menopause because there can be a dramatic decrease in bone density and an increased risk of fracture later in life,” says Dr. Watt. “Most women would like short-term therapy to get them over the hump of menopausal symptoms, so one to two years, maximum of five years (is recommended).”
Even with lower dose HT available there are still associated risks so women need to discuss their options with their physician.
“Treatment needs to be individualized for each patient,” notes Dr. Watt, who points to vaginal tablets and creams as alternatives to HT that is ingested.
“The final chapter on hormone therapy has not been written and it’s always an evolution.”